【摘要】 目的　评估双滤过法血浆分离 (DFPP)联合Daclizumab(Dac ,达昔单抗 ;商品名 :Zenapax ,赛尼哌 )对肾移植致敏受者的治疗效果及安全性。　方法　采用ELISA方法监测肾移植受者体内群体反应性抗体 (PRA)水平。 113例致敏受者分为预处理组 (72例 )和未处理组 (41例 ) ,预处理组根据是否联合Dac诱导治疗分为DFPP治疗亚组 (44例 )和DFPP联合Dac治疗亚组 (2 8例 )。比较各组受者超急性排斥反应 (HAR)和急性排斥反应 (AR)的发生率 ,并随访人 /肾 1年存活率 ,观察治疗及随访期间有无毒副作用发生。　结果　预处理组治疗前后PRA由 (6 0 .5± 17.7) %降至 (19.3± 11.2 ) % ,P <0 .0 0 0 1,差异有统计学意义。预处理组术后HAR/AR发生率为 1.4 % / 2 7.8% ,未处理组为 9.8% / 4 3.9% % ,P <0 .0 5 ;人 1年存活率分别为 98.6 %和 90 .2 % ,P >0 .0 5 ;肾 1年存活率分别为 94 .4 %和 78.0 % ,P <0 .0 5。DFPP治疗亚组和DFPP联合Dac治疗亚组比较 :术后HAR发生率分别为2 .3%和 0 % ,P >0 .0 5 ;AR发生率分别为 36 .4 %和 14 .3% ,P <0 .0 5 ;人 /肾 1年存活率分别为 97.8% / 93.2 %和 10 0 .0 % / 96 .4 % ,P >0 .0 5。DFPP和Dac治疗及随访期间无明显毒副作用发生。　结论　DFPP可以选择性去除受者体内的致敏抗体 ,与Dac更多还原

【Abstract】 Objective To investigate the clinical eff ic acy and safety of double filtration plasmapheresis (DFPP) combined with daclizum ab(Dac)in the treatment of sensitized recipients of cadaver kidney transplanta tion. Methods Panel reactive antibody (PRA) was examined with ELISA before transplantation.A total of 113 sensitized recipients (PRA>20% ) were assigned to 2 groups according to study intervention: group A ( n =72) receiving DFPP and group B ( n =41) as controls.Group A was subdivided into 2 groups:group A1 ( n =44) was treated by DFPP alone and group A2 ( n =28) was treated by DFPP plus Dac.The incidence rates of HAR,AR,adverse reaction,patie nt/kidney survival,kidney function were observed. All the patients obtained a fo llow-up ≥12 months. Results In 72 patients of group A ,the level of PRA decreased from (60.5±17.7)% to (19.3±11.2)%,with a mean of (41.2±16.9)% ( P < 0.0001).In Group A,the incidence rates of HAR and AR we re significantly lower (1.4% and 27.8%) than those in group B (9.8% and 43.9%, P < 0.05).One person-year survival was 98.6% in group A and 90.2% in gr oup B ( P > 0.05),with 1 kidney-year survival of 94.4% in group A and 78.0 % in group B ( P < 0.05).In subgroup A1 and A2,the incidence rates of HAR w as 2.3% and 0% ( P > 0.05);those of AR were 36.4% and 14.3%,respectively ( P < 0.05);the patient/kidney survival rates of 1 year were 97.8%/93.2% and 100%/96.4%,respectively ( P > 0.05).No difference in infection episodes an d adverse events between group A and PRA-negative recipients, the same as those between group A1 and A2. Conclusions DFPP can decrease the level of PRA significantly before transplantation by selectively eliminating the sensitive antibody,especially when combined with Dac,which can make sensiti zed recipients get the chance of transplanting and further reduce the incidence of AR.The patient/kidney survival rates of 1 year are satisfactory.Being well to lerated by the sensitized patients,treatment of DFPP combined with Dac is safe a nd effective.更多还原